Healthcare Provider Details

I. General information

NPI: 1447638903
Provider Name (Legal Business Name): FRANCISCAN PHYSICIAN NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E SOUTHPORT RD SUITE 100
INDIANAPOLIS IN
46227-8590
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-783-8383
  • Fax: 317-782-6929
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number99067018A
License Number StateIN

VIII. Authorized Official

Name: DONNA PHALEN
Title or Position: DIRECTOR
Credential:
Phone: 219-554-4548